Active NPI
Harold William Martindale, P.A.
- Medical Physician Assistant
- Page, AZ
National Provider Identifier
1699956102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 3747
- Practice address
- 827 Vista Ave
Page, AZ 86040-1625 - Phone
- (928) 645-9675
- Fax
- (928) 645-3030
- NPI assigned
- Nov 27, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 3747 | AZ | Primary |
Addresses
Primary practice location
827 Vista Ave
Page, AZ 86040-1625
Mailing address
440 N Navajo Dr
Page, AZ 86040-1625
Phone (928) 645-1700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3747 | Other | AZ | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3747 | AZ | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Canyonlands Community Health Care | Medical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196121600000",
"number": "1699956102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "440 N NAVAJO DR",
"city": "PAGE",
"state": "AZ",
"postal_code": "860401625",
"telephone_number": "928-645-1700",
"fax_number": "928-645-1701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "827 VISTA AVE",
"city": "PAGE",
"state": "AZ",
"postal_code": "860401625",
"telephone_number": "928-645-9675",
"fax_number": "928-645-3030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINDALE",
"first_name": "HAROLD",
"middle_name": "WILLIAM",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-27",
"last_updated": "2007-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AZ",
"license": "3747",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "3747",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Page, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.